In This Issue…

Abstract

A wide variety of clinical and basic science articles comprise this issue of the Canadian Journal of Diabetes. Some of the topics covered in this issue are included below. Cimo and Dewa present a qualitative study aimed at exploring the perspectives of adults with type 2 diabetes and mental illness. The authors studied the challenges to engaging in self-care behaviours and accessing diabetes education services (pages 372–81). They highlight the importance of addressing these issues in this population, given the increased prevalence of type 2 diabetes among individuals with mental health illnesses and poorer self-care practices and, ultimately, the poorer outcomes observed in this population. The authors conducted focus groups with individuals who self-identified as having type 2 diabetes and major depressive disorders. Transcripts were analyzed and major themes identified. Participants identified a wide range of barriers to care, including physiological, physical and social challenges. The authors suggest that addressing these issues will be necessary to close the gaps in care that currently exist in this population. Combined aerobic and anaerobic exercise improved the oxidative capacity of skeletal muscle and improved insulin sensitivity in a rodent model of type 1 diabetes, according to the authors of this study (pages 404–11). The improvement in the oxidative capacity of muscle in the combined aerobic and anaerobic group was greater than that of the aerobic-only group. This result led the authors to suggest that combined exercise training may result in a synergistic effect on the oxidative capacity of muscle. Contrary to their original hypothesis, combined aerobic and anaerobic exercise did not reduce lipid accumulation in the skeletal muscle; this was seen in the aerobic-only exercise group. The authors hypothesize that although lipid stores were not decreased, the composition of the lipid stores may differ in the combined aerobic and anaerobic exercise group. They suggest that the fat stores in the aerobic- and anaerobic-exercised rodents are potentially composed of energy-rich neutral triacylglycerol molecules in comparison to the insulin-desensitizing diacylglycerol molecules seen in unexercised animals. Thus, the animals undergoing combined aerobic and anaerobic exercise would have access to energy stores without the effect of insulin resistance. The authors suggest that combined exercise may promote positive metabolic adaptation with increased capacity to both store and oxidize lipids, compared with aerobic activity alone. This is an intriguing hypothesis that is yet to be confirmed among those living with type 1 diabetes. Increased awareness of the criteria and contraindications for islet-cell transplantation is needed for people living with type 1 diabetes and health-care providers, according to Ling et al (pages 419–25). In this article, the authors describe the referral patterns and initial eligibility assessment for the largest clinical islet-cell transplant program in Canada. The authors undertook a retrospective chart review (2009 to 2012) to identify the most common factors resulting in an applicant's being deemed eligible or ineligible for islet-cell transplantation. Overall, only 19% of applicants were deemed acceptable for listing for transplant. The majority of applicants were self-referrals, and among the indications for no transplant, severe hypoglycemia and glucose lability were the most common causes of ineligibility. In addition, the use of a suboptimal insulin regimen was the most common exclusion criterion identified. The majority of applicants were from Alberta. Only a small number of applications came from the 2 most populous provinces (Ontario and Quebec), despite neither of these provinces having a transplant program at the time. In addition to increasing awareness of eligibility for islet-cell transplantation, the authors suggest that their findings can be used as benchmarks for future studies and ongoing program evaluation. Conflicts of interest: None.